We propose creating an integrated Center for patient-centered outcomes research (PCOR) and comparative effectiveness research (CER) at the University of Texas Southwestern Medical Center in Dallas (UTSW), Parkland Health and Hospital System (Parkland), Children's Medical Center (Children's), and the North Texas Veterans Administration Health Systems (Dallas VA). The theme of the Center is PCOR/CER in underserved patients, populations, and settings, including those served by safety net systems. We will leverage the resources at UTSW, Parkland, Children's, Dallas VA, UTSW CTSA and all UTSW academic institutions, and broadly engage stakeholders needed to achieve the following aims: 1. Develop the infrastructure and programs to increase expertise and research activity in PCOR/CER. 2. Create formal education, training, mentorship and career development activities in PCOR/CER for faculty, trainees, and students, and expand understanding of PCOR/CER across our campus. 3. Establish the structures, policies and procedures needed to support meaningful stakeholder engagement. 4. Conduct PCOR/CER to improve the outcomes of care among underserved patients and populations. 5. Disseminate findings to researchers, health systems, and local, state and national stakeholders. 6. Perform formative and summative evaluation of our progress and overcome any barriers to success. We have strong financial commitments from the leaders of all UTSW and partner institutions. Three projects will harness data in the electronic medical record to conduct observational and interventional studies to improve care for high risk, underserved patients and populations. All projects will engage stakeholders throughout the research, implementation, and dissemination process. We will partner with the AHRQ-funded Johns Hopkins University EPC and DEclDE Centers of Excellence. We will collaborate with our 5 other sister Univ. of TX Health Science Centers (in Houston, San Antonio, Galveston, Tyler) ~all who have safety net affiliates to disseminate our findings. All activities aim to promote PCOR/CER to improve the delivery of care to the underserved that is patient-centered, evidence-based, high quality, equitable, and efficient.